1. Field Of The Invention
The present invention is directed to surgical instruments for use in vitrectomies and the like, and more specifically to an improved illuminated leading probe device for intraocular surgery which enables the user to do bimanual operations within the eye. It is also directed to a method of using the devices. The device of the present invention relies upon defined optical fiber and probe configuration, as more fully developed below.
2. Prior Art Statement
Operations in the so-called vitreous body of the eye (vitrectomies) are carried out under the operating microscope. Various lighting techniques and devices have been developed for such surgeries. To obtain reflux-free illumination during such procedures, the illuminating beam and the observation beam have to be separated. This is accomplished by introducing illuminating beams into the eyeball. The entry site for such devices is in all cases the so-called "pars plana" at the transition between the anterior 1/3 and the posterior 2/3 of the eyeball. Up to now, the following illumination systems are known:
1. Metallic sleeves containing illuminated glass fibers in their walls are slid over the vitrectomy instruments and are introduced into the eye together with those instruments. Due to the materials used, the diameter of such sleeves is relatively large and their illuminating capacity relatively low, Moreover, the light emerging from the sleeve illuminates only the tip of the vitrectomy instrument and the tissues immediately adjacent to it. The rest of the vitreous cavity remains dark. PA1 2. Fiber-optic probes consist of a bundle of glass fibers assembled in a metal tube, carried through a hand-piece and connected to a light source. Such probes have a diameter of about 20 gauge. For their insertion into the eye, they require a separate incision in the pars plana. Their advantage lies in the reduction of the total diameter of the instruments to be introduced into the eye. Due to the materials used, the illumination obtained is relatively low. When employing wide angle observation systems, such probes need to be retracted as far as possible, because their angle of illumination is rather small. For this reason, they often slide out of the entry site and need to be re-introduced again. Their main disadvantage is the fact that they completely occupy one hand of the surgeon so that the actual surgical manipulations have to be performed with the one remaining hand.
The so-called "Deckenlampen" (literally "ceiling light") light sources are short, stubby light guides consisting of one single thick fiber or a bundle of several fibers. They are introduced into the eye in the region of the pars plana and are fixed upon the eyeball. As a disadvantage, such "ceiling lights" require their own additional incision in the pars plana, thus increasing the trauma of the surgical intervention. In addition, the materials employed so far do not carry much light and their angle of illumination is not particularly wide.
European Patent Application Publication Number 0201280 A2, filed by Tokyo Kogaku Kikai Kabishiki Kaisha, describes a short tube with a length of only a few millimeters and light fibers integrated into its wall. The tube is introduced into the vitreous body at the pars plana and fixed on the outer wall of the eye by means of a foot plate. The lumen of the tube carries an O-ring and serves to introduce an infusion into the eye. The device is meant to render both hands of the surgeon free for active bi-manual intraocular surgery. The device is not very bright and the illuminating angle is rather small. The tube cannot be used for the introduction of instruments other than the infusion. Due to the rather axial illuminating beam, the surgeon must use one hand to guide the course of the light beam in the eye. Bi-manual maneuvers can only be carried out if an assistant directs the light beam, which is rather difficult to do because of the lack of space in the surgical field outside the eye. For the operation, one then separately uses the appliance with the prior art light source which leads to a highly focused overall lighting and may lead to light toxicity to the back of the eye.
Prior art disadvantages are effectively eliminated and replaced by the present invention. Light conducting fibers with extremely small diameters are used so that the entire diameter of the part of the leading probe device placed into the "Pars plana" entails only about 1.5 mm to 1.7 mm. In the present invention device, simultaneous illumination and instrument insertion is achieved, eliminating a separate opening, reducing risks, increasing light guidance and illumination accuracy and freeing a hand so that bimanual operations are easily accomplished by the surgeon.